POLYMYALGIA RHEUMATICA

I. Clinical features

  1. Age >50y
  2. Pain & morning stiffness x 30min or longer (in 2 or more of: neck, shoulders, torso, hip) for 1mo or more and
  3. Elevated ESR (> 40; often >100)
  4. Normal CPK
  5. Normal mm. strength though "breakaway muscle pain"
  6. Fever, malaise, fatigue
  7. Anemia, altered LFT's (esp. alk-phos), elevated CRP, polyclonal gammopathy
  8. 25% will develop temporal arteritis

II. Treatment

  1. Low-dose Corticosteroids typically used
    1. Generally given 10-20mg/d then slow taper, e.g. drop dose 2.5mg/d/month till at 10mg/d, then decrease by 1mg/d/month till off
    2. Flares ,ay occur during taper; use symptoms/ESR to guide alterations in tx
    3. Often treated for as long as 2 years
  2. Methotrexate
    1. 72 pts with PMR, all on prednisone 25mg/d tapering over 6mos (but capable of being restarted as symptoms dictated), randomized to methotrexate (10mg Qwk + folinic acid 7.5mg Qwk) vs. placebo x 48wks; at 18mos, sig. fewer methotrexate pts were on corticosteroids (12% vs. 47%) or had one or more flare-ups (47% vs. 73%) (Ann. Int. Med. 141:493, 2004--JW)